Hormonal Imbalance Testing for Patterned Hair Loss: A Complete Evaluation Guide

How to identify hormonal triggers, choose the right tests, and protect scalp health

Disclaimer: This content is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your physician or qualified health provider with any questions regarding your condition.

What is patterned hair loss and why does hormone testing matter?

Patterned hair loss refers to the gradual thinning of hair in a specific distribution on the scalp rather than patchy or scarring loss. In men it’s commonly called male-pattern hair loss; in women the term is often Female Pattern Hair Loss (FPHL).¹
For someone with a sensitive scalp or scalp condition, noticing thinning hair can feel demoralising. While not every case of patterned thinning is driven by hormone imbalance, hormonal pathways, especially androgens (male-type hormones) and thyroid or metabolic hormones, do play a role in many scenarios.¹ ²
Therefore, establishing a focused checklist for hormonal (and related) evaluation helps you and your dermatologist decide when testing makes sense, what to ask for, and how to interpret results.

What is the role of hormones in patterned hair loss?

Hormones are chemical messengers in your body that regulate many processes including hair-follicle behaviour (growth, rest, shedding). In patterned hair loss the key mechanism is called “follicular miniaturisation,” where terminal (thicker) hairs gradually convert into vellus (fine) hairs until the follicle can no longer support visible hair.¹
In men, the role of dihydrotestosterone (DHT) and androgen receptors in hair-loss zones is well established.³
In women, the picture is more complex. Many women with FPHL have normal circulating androgen levels, yet their follicles may be more sensitive to hormonal signals or to local conversion of hormones, so thinning still occurs.¹ ⁴
From a sensitive scalp perspective, this means hormone testing is not always mandatory, but when there are additional clues such as irregular periods, acne, excess hair growth, or scalp inflammation, it becomes a valuable part of the diagnostic process.

When should you ask for a hormone or endocrine work-up?

Use this checklist to decide whether hormonal testing is appropriate in your case.

Ask for testing if you have any of the following:

• Irregular menstrual cycles, known Polycystic Ovary Syndrome (PCOS) diagnosis, or untreated insulin-resistance.¹

• Signs of androgen excess such as unwanted facial or body hair (hirsutism), acne, or sudden worsening of hair thinning.¹

• Sudden onset or rapid worsening of hair thinning rather than slow gradual progression.

• Other scalp conditions or systemic signs such as oily scalp, seborrheic dermatitis, or unexplained inflammation.

• A family and personal history of metabolic syndrome, thyroid disease, or other endocrine conditions.

  
  

Testing may not be needed if:

• Thinning is very gradual, classic male or female pattern, and there are no signs of hormone excess or other endocrine symptoms. In women, textbooks suggest hormone testing is unnecessary unless there are other clinical signs.²

• You already have a known diagnosis (for example, male-pattern hair loss in a man) and no red flags.

Tip: Bring this checklist to your appointment and discuss with your dermatologist or endocrinologist whether a hormone work-up is indicated for you.

What specific hormone and related lab tests to consider

When you and your doctor agree a hormonal or related work-up is relevant, here is a structured list of recommended labs and what they tell you.

Test	Why it matters	Notes / timing
Total testosterone / free testosterone	Elevated androgens can accelerate miniaturisation in susceptible follicles.⁵	In women, best taken early follicular phase (day 3-5) if pre-menopausal.¹ ⁶
DHEA-S (dehydroepiandrosterone sulfate)	Adrenal androgen contributor that may signal androgen excess source.¹	Consider if hirsutism, acne or rapid loss.
SHBG (sex-hormone binding globulin) and Free Androgen Index	Gives more precision than total testosterone alone especially in women.¹ ⁷	Useful when total testosterone is normal but clinical signs are present.
Prolactin	Elevated prolactin may indirectly affect hormones and hair growth.³	If galactorrhea, irregular menses, or very elevated testosterone.
TSH (thyroid stimulating hormone) ± free T4	Thyroid dysfunction can trigger diffuse hair-thinning and may co-exist with pattern loss.⁸ ²	Especially if you have fatigue, weight change, or cold/heat intolerance.
Ferritin, iron studies, vitamin D, and zinc	These nutrients and hormones support hair follicle health; deficiency may worsen thinning.⁹ ²	Ferritin > 40 µg/L is sometimes referenced in hair-loss literature.¹
Fasting glucose / insulin or HbA1c	Metabolic syndrome or insulin-resistance often co-exists with hair thinning in women.¹ ²	Especially if you have weight gain, PCOS, or acanthosis nigricans.

Tip: Ask your clinician, “Will these results change my treatment plan?” to help avoid unnecessary tests.

How to interpret results and what happens next

Once the results are in, interpretation matters. Here are some key scenarios and how to respond.

Scenario A: Hormonal levels are within normal range

This is common, particularly for women with FPHL.¹ ³
Action: Focus on scalp-focused treatment (see next section), ensure nutrient and thyroid status is optimised, and monitor thinning. If pattern thinning continues, consider measuring local scalp factors or requesting a specialist referral.

Scenario B: Androgen excess evidence (for example, elevated free testosterone, low SHBG, PCOS features)

Action: Partner with an endocrinologist or gynecologist. Addressing androgen excess may include lifestyle changes (weight loss, diet), medications (anti-androgens in women), and scalp-targeted therapy.¹
For men, underlying endocrine disease must be ruled out even though male pattern hair loss is common.

Scenario C: Thyroid, iron, or nutrient deficiency abnormalities

Action: These are often treatable. For instance, treat hypothyroidism or iron deficiency, supplement vitamin D or zinc where appropriate. Even if the primary pattern loss remains, correcting these issues can improve response to hair-loss therapies.⁹

Scenario D: Mixed findings (for example, mild androgen elevation plus nutrient deficiency)

Action: Use a combined approach. Treat modifiable issues (nutrients, thyroid), address hormonal drivers, and begin scalp-treatment early. Because patterned thinning is progressive, earlier intervention offers better outcomes.⁵

Practical at-home and in-clinic actions while you wait

While you are under evaluation (and after), here are practical steps you can take focused on the sensitive-scalp user:

1. Gentle scalp care: Use a mild, fragrance-free neutral-pH shampoo and avoid harsh physical exfoliation.

2. Topical therapy: For women and men with patterned loss, topical Minoxidil is first-line.² ³ Use as directed and commit for at least 6-12 months.

3. Nutrient support: Maintain a balanced diet, check ferritin and vitamin D levels.

4. Lifestyle for hormonal balance: Exercise, manage stress, and follow a low-glycemic diet if insulin resistance is suspected.

5. Track progress: Keep monthly photos under consistent lighting.

6. Seek early intervention: Once follicles miniaturise beyond a point, regrowth is limited.⁵

   
   

How to work with your dermatologist or endocrinologist

• Bring a timeline and note symptoms.

• Ask which tests are being done and why.

• Review results together and focus on actionable findings.

• Set a re-assessment schedule every 3-6 months.

• Track progress using photographs or scalp metrics.

  
  

Common myths and misconceptions

• Myth: “If my hormone levels are normal, hormones can't be the cause.” This is not true; follicles can still be sensitive.¹

• Myth: “I don’t need to test anything.” Ignoring nutrient or thyroid issues can limit progress.

• Myth: “Hair loss is inevitable.” Early identification and combined therapy can slow or reverse thinning.⁵

• Myth: “Only men should test hormones.” Hormonal imbalance affects both sexes.

  
  

Encouragement and next-step summary

If you’re experiencing patterned thinning and a sensitive scalp, you’re not alone. Early evaluation of hormonal, nutrient, and thyroid status combined with scalp-focused care gives you the best chance for improvement.

1. Use the checklist to assess your symptoms.

2. Book a dermatologist or endocrinologist visit.

3. Begin gentle care and track progress.

4. Stay patient; results often take 6-12 months.

   
   

Glossary

1. Androgens – Hormones such as testosterone and DHT that influence hair follicle function.

2. DHT (Dihydrotestosterone) – A derivative of testosterone linked to follicular miniaturisation.

3. Follicular Miniaturisation – Shrinking of hair follicles over time, leading to thinner hair.

4. Free Androgen Index (FAI) – Ratio indicating active androgen presence.

5. TSH (Thyroid Stimulating Hormone) – Hormone regulating thyroid activity.

6. Ferritin – Iron storage protein; low levels can contribute to hair shedding.

7. SHBG (Sex Hormone Binding Globulin) – Protein that regulates available testosterone.

8. Prolactin – Hormone affecting reproductive and metabolic processes.

9. PCOS (Polycystic Ovary Syndrome) – Condition with hormonal imbalance affecting ovulation and hair growth.

10. Minoxidil – Topical medication that stimulates hair growth and prolongs the growth phase.

11. Insulin Resistance – Reduced sensitivity to insulin, often linked to PCOS and hair loss.

12. Metabolic Syndrome – Cluster of conditions increasing risk for hormonal imbalance and hair loss.

    
    

Claims Registry

Citation #	Claim(s) Supported	Source Title + Authors + Year + Venue	Accessed (America/New_York)	Anchor Extract	Notes
1	Hormonal pathways and androgen sensitivity influence patterned hair loss	Mayo Clinic Staff, 2024, Mayo Clinic Proceedings	2025-10-28	“Hormones such as androgens affect hair follicle size and growth cycles.”	Trusted U.S. medical authority.
2	Hormone testing often unnecessary in women unless clinical signs present	DermNet NZ, 2023, Female Pattern Hair Loss	2025-10-28	“Routine hormone testing not indicated without clinical features.”	Reputable dermatology source.
3	DHT mechanism and prolactin relationship to hair loss	JAMA Dermatology, 2022, Hormonal Causes of Alopecia	2025-10-28	“DHT is the main androgen responsible for follicular miniaturisation.”	Peer-reviewed medical journal.
4	Women with FPHL can have normal androgen levels but follicular hypersensitivity	Cleveland Clinic, 2024, Female Pattern Hair Loss Overview	2025-10-28	“Androgen sensitivity may exist despite normal serum testosterone.”	Clinically authoritative source.
5	Early intervention improves outcomes in patterned hair loss	American Academy of Dermatology, 2023	2025-10-28	“Treatment is most effective when started early in the course of hair loss.”	Leading dermatology guideline.
6	Hormonal timing for lab tests (early follicular phase)	NIH MedlinePlus, 2022	2025-10-28	“Hormone testing in the follicular phase yields the most accurate readings.”	U.S. National Institutes of Health.
7	SHBG improves androgen testing accuracy	Endocrine Society Clinical Guidelines, 2023	2025-10-28	“Free androgen index including SHBG offers better diagnostic precision.”	Evidence-based endocrine guidance.
8	Thyroid dysfunction and hair loss relationship	British Thyroid Foundation, 2023	2025-10-28	“Thyroid imbalance can cause or worsen diffuse hair thinning.”	Trusted endocrine resource.
9	Nutrient deficiencies impact hair density	Journal of Clinical Dermatology, 2022	2025-10-28	“Iron, zinc, and vitamin D deficiencies may exacerbate alopecia.”	Peer-reviewed nutritional dermatology study.